Anderson Daren, Porto Anthony, Koppel Jonathan, Macri Giuseppe, Wright Megan
Weitzman Institute, Middletown, Connecticut, USA.
Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, Connecticut, USA.
Telemed J E Health. 2020 Nov;26(11):1383-1390. doi: 10.1089/tmj.2019.0238. Epub 2020 Feb 5.
Access to endocrinologists is a particular challenge for medically underserved populations. Electronic consultations (eConsults) are a promising tool to help address this problem. This retrospective cohort study compared two groups: (1) Medicaid patients referred to an endocrinologist 1 year before the implementation of eConsults and (2) those referred in the 1 year after implementation. Data included patient demographics, dates of referral requests, appointment dates, eConsult response dates and times, diagnosis codes, and consultants' recommendations. Provider perspectives of eConsults were determined by using a survey. Before eConsult implementation, only 138 out of 365 (37.8%) of referrals to endocrinology were completed. Postimplementation, 281 out of 469 (59.9%) of referrals were completed either by a confirmed face-to-face visit with an endocrinologist or by an eConsult, of whom 194 (41.4%) did not require a face-to-face visit. Thyroid conditions were the most common reason for a consult, accounting for roughly 40% of all consults. Overall, 32 out of 36 (89%) primary care providers (PCPs) indicated that they were satisfied with eConsults and 19 out of 36 (53%) felt that the process did not create additional work or burden for them. These findings demonstrate that eConsult use can help address poor access to specialty care for Medicaid-insured patients. eConsults were able to significantly decrease the need for face-to-face visits and enabled PCPs to address specialty-related issues in primary care. Widespread adoption of eConsults could be a potential solution for major challenges that our health care system faces today.
对于医疗服务不足的人群来说，接触内分泌科医生是一项特别具有挑战性的事情。电子会诊（eConsults）是一种很有前景的工具，有助于解决这个问题。这项回顾性队列研究比较了两组：（1）在电子会诊实施前1年被转诊至内分泌科医生处的医疗补助计划患者，以及（2）在实施后的1年中被转诊的患者。数据包括患者人口统计学信息、转诊请求日期、预约日期、电子会诊回复日期和时间、诊断代码以及会诊医生的建议。通过一项调查确定了医疗服务提供者对电子会诊的看法。在电子会诊实施前，365例转诊至内分泌科的患者中只有138例（37.8%）完成了会诊。实施后，469例转诊患者中有281例（59.9%）通过与内分泌科医生进行确认的面对面就诊或通过电子会诊完成了会诊，其中194例（41.4%）不需要面对面就诊。甲状腺疾病是会诊的最常见原因，约占所有会诊的40%。总体而言，36名初级保健提供者（PCP）中有32名（89%）表示他们对电子会诊感到满意，36名中有19名（53%）认为该过程没有给他们带来额外的工作或负担。这些发现表明，使用电子会诊有助于解决医疗补助保险患者获得专科护理困难的问题。电子会诊能够显著减少面对面就诊的需求，并使初级保健提供者能够在初级保健中解决与专科相关的问题。广泛采用电子会诊可能是解决我们医疗保健系统当今面临的重大挑战的一个潜在解决方案。
